tbuckley/cabot-search huggingface dataset:
Abstract 11136: Diagnostic and Therapeutic Practices of Pulmonary Arterial Hypertension in Patients With Sarcoidosis in the United States: A Nationwide Registry Study
Authors: Mohammad As Sayaideh, Moustafa Younis, Bashar Alzghoul
Journal: Circulation (2022)

Introduction: Patients with advanced sarcoidosis may develop Pulmonary Hypertension (PH). Sarcoidosis related PH was most frequently seen in patients with fibrotic disease and comes with increased mortality. We describe diagnostic modalities and management strategies used in patients with sarcoidosis associated PH in the United States (US). Methods: We conducted a retrospective study based on a national registry investigating 3,835 respondents to the Foundation for Sarcoidosis Research (FSR-SARC). The registry includes patient surveys completed between June 2014 and August 2019. Summary and univariate analyses were performed. Results: A total of 211 (6%) patients with PH with a mean (±SD) age of 42 (13) years were identified; 139 (66%) were women, 126 (60%) Caucasian and 69 black (33%). Patients with PH were younger (mean age, years +-SD) {42+-13 vs 44+-12; p=0.008}. Patients with PH were more likely to be women (OR: 1.5, 95%CI:1.1-2.0, p=0.006) and less likely to be Caucasian (Caucasian: 5%, Black: 16%, other:15%, p&lt;0.0001).PH therapy: 27 (13%) received phosphodiesterase inhibitors including sildenafil or tadalafil, 12 (6%) received endothelin receptor antagonist including ambrisentan, macitentan or bosentan, 5 (2.4%) received IV therapy including Treprostinil, iloprost or epoprostenol, 3 (1.4%) inhaled treprostinil, 2 (0.9%) received an oral prostacyclin and 2 (0.9%) received riociguat. Sarcoidosis therapy received by patients with PH: 166 (79%) steroids, 96 (46%) cytotoxic medications and/or 40 (19%) TNF inhibitor. Patients with PH were more likely to receive cytotoxic medications (OR: 1.5, 95%CI:1.1-1.9, p=0.008) and TNF inhibitors (OR: 1.7, 95%CI:1.2-2.4, p=0.004). However, there was no significant difference in steroid use between patients with and without PH (OR: 1.2, 95%CI:0.9-1.7, p=0.30). Conclusions: Non-Caucasian, younger females with sarcoidosis were more at risk for PH. Phosphodiesterase inhibitors are the most commonly used class in this population. Patients with PH were more likely to receive more aggressive sarcoidosis therapy with cytotoxic meds +/-TNF inhibitors.
Abstract 11327: De Novo Heart Failure in a Young Adult: A Case of Severe Aortic Regurgitation Secondary to an Aortic Root Aneurysm in a Patient With Marfan's Syndrome
Authors: Dayana Orozco -Sepulveda, Dario Mencia-Amador, RAMON E SANTALO, Jorge Eduardo Hernandez del Rio, Tomas Miranda - Aquino
Journal: Circulation (2022)

A 24-year-old male, with no past medical history, presented to the ER with a 15-day history of insidious abdominal pain and distention, associated with progressive dyspnea on exertion and bilateral lower extremity pitting edema. In the previous 48 hours before his hospital admission, patient began presenting orthopnea and paroxysmal nocturnal dyspnea.On presentation patient was normotensive and tachycardic, with low oxygen saturation on pulse oximetry. On auscultation a loud early diastolic decrescendo murmur was heard at the parasternal border, with and audible S3 gallop. Characteristic Marfanoid habitus was observed. Patient underwent TTE were there was a notable aortic root dilation, mainly at the level of the sinuses of Valsalva, which had a diameter of 85 mm and 62 mm at the sinotubular junction. Ascending and descending aorta had a normal diameter. An eccentric jet of severe aortic regurgitation was also noted, which collided with the anterior mitral valve leaflet causing an Austin Flint phenomenon. Left ventricular ejection fraction was estimated at 24%, severe dilation was noted on all chambers. There were no echocardiographic signs of aortic dissection. Patient underwent genetic testing and ophthalmic evaluation, confirming the diagnosis of Marfan’s syndrome. A contrast enhanced CT angiogram confirmed the presence of severe aortic root dilation without dissection. Patient underwent Bentall procedure and began treatment for HFrEF at discharge. Marfan Syndrome is an autosomal dominant connective tissue disorder, due to mutations mostly in the FBN1 gene. Most cardiovascular symptoms are related to dilation of the aortic root and subsequent aortic regurgitation due to aortic annulus dilation. In patients with Marfan’s syndrome, all aortic root aneurysms ≥5.0 mm should undergo surgical repair regardless of symptoms.
Abstract 12399: Impact of Heart Failure and Chronic Kidney Disease on Clinical Outcome in Relation to Presence of Type-2 Diabetes Mellitus - Results From the Population-Based Gutenberg Health Study
Authors: Sven Troebs, Juergen H Prochaska, Anna Stuermlinger, David Velmeden, Ludwin Ley, Felix Mueller, Marc Heidorn, Alexander Schuch, Thomas Koeck, Andreas Schulz, Irene Schmidtmann, Matthias Michal, Andreas Schuster, Oliver Tuescher, Julia Weimann-Menke, Joern M Schattenberg, Karl J Lackner, Thomas Muenzel, Philipp S Wild
Journal: Circulation (2022)

Background: Type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD) are pathophysiologically linked and impact clinical outcome. The aim of this study was to determine the co-prevalence of T2DM, CKD and HF and to evaluate their additive prognostic significancefor all-cause mortality. Methods: Data from the population-based, prospective Gutenberg Health Study were analyzed (n=15,010). Clinical parameters were assessed during a highly standardized comprehensive 5-hour investigation at a dedicated study center. HF, T2DM and CKD were defined according to international guidelines. All-cause mortality was determined by regular checks of vital status via standardized follow-up examinations and regular alignment with registration offices. Results: In total 14,872 individuals were eligible for analysis (prevalence of T2DM: 8.6%; CKD: 29.1%; HF: 3.3%). During a median follow-up of 11.8 [interquartile range 10.3-13.2] years, 1,281 individuals died. In Cox regression analysis adjusted for age and sex, CKD and HF independently denoted an increased risk for all-cause mortality in diabetics (hazard ratio (HR) CKD 1.67 [95% confidence interval 1.33-2.09], P&lt;0.0001; HR HF 2.44 [1.86-3.20], P&lt;0.0001) and non-diabetics (HR CKD 1.22 [1.07-1.41], P=0.0042; HR HF 2.55 [2.07-3.14], P&lt;0.0001). Further adjustment for traditional cardiovascular risk factors (CVRF) marginally reduced effect estimates. When considering the interaction of CKD and HF in Cox regression analysis, adjusted for age, sex, and CVRF, CKD without HF indicated a higher risk for all-cause mortality in diabetics (HR 1.66 [1.28-2.14], P=0.00011) compared with non-diabetics (HR 1.17 [1.01-1.36], P=0.04). A similar pattern, but with higher estimates was detected for HF without CKD (HR T2DM 2.56 [1.63-4.00], P&lt;0.0001 vs. HR non-diabetics 2.13 [1.60-2.83], P&lt;0.0001), and the highest were found for the co-prevalence of CKD and HF (HR T2DM 3.69 [2.59-5.27], P&lt;0.0001 vs. HR non-diabetics 3.44 [2.54 - 4.65], P&lt;0.0001). Conclusion: CKD and HF each show an independent but different risk for all-cause mortality that is modified by the prevalence of T2DM. The co-prevalence of these diseases increases mortality, underscoring the need for a holistic treatment approach.
Abstract 11545: The Role and Impact of a Women in Cardiology Mentorship Program on Female Residents
Authors: Jenna Spears, Jeanine E Romanelli
Journal: Circulation (2022)

Introduction: Women are underrepresented in Cardiology, especially in interventional specialties. This study sought to evaluate the impact that a formal Women in Cardiology (WIC) mentorship program would have on female internal medicine residents. Hypothesis: We hypothesized that a formal mentorship program would positively impact female residents’ decision to pursue a career in Cardiology, and hoped to highlight this through this study. Methods: A formal WIC Mentorship Program was established at our institution, which featured educational content, open discussions and networking opportunities. Members of the program included female cardiologists from various sub-specialties, cardiology fellows and medical residents. An anonymous survey was then conducted to evaluate the impact of this program on female residents. This survey was completed by 100% of the participants. Results: After involvement in the WIC mentorship program female residents indicated that they: 1) were more interested in pursuing a procedural subspecialty (interventional cardiology or electrophysiology) (5/7, 71.43%); 2) were more comfortable approaching female fellows and attendings (7/7, 100%); 3) were more aware of the diversity of possible careers in Cardiology (6/7, 85.71%) 4) felt female mentorship was important for their future career (7/7, 100%) 5) found the program helpful and would attend future meetings (7/7 100%). Potential factors that discouraged women from pursuing cardiology were explored. The majority of residents indicated that concerns over work-life balance had discouraged them (4/7; 57.14%). A smaller portion of residents indicated concerns over radiation exposure (2/7; 28.57%) and discrimination (3/7; 42.86%) had discouraged them. All residents subsequently indicated that their concerns were addressed and lessened by the mentorship program. Conclusions: The importance and positive impact of mentorship were highlighted in this study. The adoption of similar mentorship programs across other institutions may be utilized to encourage interested female residents to pursue a career in cardiology, especially in procedural subspecialties.
Abstract 12127: Protein Disulfide Isomerase A1 as Novel Redox Sensor in VEGFR2 Signaling and Angiogenesis
Authors: Sheela Nagarkoti, Young-mee N Kim, Dipankar Ash, Archita Das, Eric Vitriol, Seock-Won Youn, Sudhahar Varadarajan, Malgorzata McMenamin, Yali Hou, Harriet Boatwright, Ruth B Caldwell, David W Essex, Jaehyung Cho, Tohru Fukai, Masuko Ushio-Fukai
Journal: Circulation (2022)

Background: VEGFR2 signaling in endothelial cells (ECs) is regulated by reactive oxygen species (ROS) derived from NADPH oxidases (NOXs) and mitochondria, which plays an important role in postnatal angiogenesis. However, it remains unclear how highly diffusible ROS signal enhances VEGFR2 signaling and reparative angiogenesis. Protein disulfide isomerase A1 (PDIA1) functions as an oxidoreductase depending on the redox environment. However, role of PDIA1 in ROS-dependent VEGFR2 signaling and angiogenesis is entirely unknown. Results: Here we showed that PDIA1 co-immunoprecipitated with VEGFR2 or colocalized with either VEGFR2 or early endosome marker Rab5, but not late endosome marker Rab7, at the perinuclear region in human ECs in response to VEGF. PDIA1 silencing significantly reduced VEGF-induced EC migration (43.3%), proliferation (52.8%) and spheroid sprouting via inhibiting VEGFR2 signaling. Mechanistically, VEGF stimulation rapidly increased Cys-OH formation of PDIA1 via the NOX4-mitochondrial ROS axis. Experiments using “redox-dead” mutant PDIA1 with replacement of the active four Cys residues with Ser revealed that VEGF-induced PDIA1 CysOH formation promoted angiogenic responses by increasing phosphorylation of VEGFR2 at Y1175 via oxidative inactivation of PTP1B. In vivo, Pdia1+/- mice showed impaired angiogenesis in developmental retina and Matrigel plug models as well as ex vivo aortic ring sprouting model. Hindlimb ischemia model revealed that PDIA1 expression was markedly increased in angiogenic CD31 positive ECs of ischemic muscles, and that limb perfusion recovery and neovascularization (48%) in response to ischemic injury were significantly impaired in EC-specific Pdia1 conditional knockout mice. Conclusion: PDIA1 can sense VEGF-induced H2O2 signal via CysOH formation to promote VEGFR2 signaling and angiogenesis in ECs via oxidative inactivation of PTP1B, thereby enhancing postnatal angiogenesis. The oxidized PDIA1 is a potential therapeutic target for treatment of ischemic vascular diseases
Abstract 12689: Electron Transport Chain Inhibition to Decrease Reperfusion Injury in Transplanted Donation After Circulatory Death Rat Hearts
Authors: Mohammed Quader, Qun Chen, Oluwatoyin E Akande, Renee Cholyway, Eleonora Mezzaroma, Edward J Lesnefsky, Stefano Toldo
Journal: Circulation (2022)

Introduction: Intrinsic to the donation after circulatory death (DCD) donation is ischemia and reperfusion injury, primarily mediated through release of reactive oxygen species (ROS) from the damaged mitochondria. Amobarbital (AMO) is a transient, reversible inhibitor of complex I known to decrease ROS generation. We studied whether AMO treatment during reperfusion can improve function in transplanted DCD hearts. Methods: Sprague Dawley rats, were assigned to four heart donor groups- DCD or DCD+AMO and control beating-heart donor (CBD) or CBD+AMO (n=6-8 each). Donor rats were anesthetized using ketamine/xylazine, intubated and connected to a ventilator. The carotid access was used to deliver heparin (1000 U/kg) and vecuronium bromide (4 mg/kg) to paralyze diaphragmatic muscles. The DCD process was initiated by disconnecting the ventilator. Donor hearts were procured following 25 minutes of in-vivo ischemia in the DCD groups, while CBD hearts were procured without terminating the ventilation. At procurement, after clamping the aortic arch, all donor hearts received 10 ml of University of Wisconsin cardioplegia solution delivered through the carotid cannula. The CBD+AMO and DCD+AMO groups received AMO (2 mM), dissolved in the cardioplegia. Heterotopic heart transplantation was performed in recipient rat’s abdomen. After 14 days the transplanted heart function was measured with a balloon tip catheter. Results: Compared to CBD hearts, DCD hearts had significantly lower developed pressure, the rate pressure product (developed pressure times heart rate), and negative dP/dt indicating decreased contractile and impaired diastolic function (Figure). AMO treatment of the DCD hearts resulted in significantly improved cardiac function compared to the untreated DCD hearts. Conclusions: A single treatment with AMO during the heart procurement improves the transplanted DCD heart function which was comparable to the control CBD hearts.
Abstract 12425: The Interplay Between Left Atrial and Mitral Valvular Remodeling in Subtypes of Mitral Regurgitation
Authors: Christian Engelsen Berg-Hansen, Rasmus S Bach, Lisa M Grymyr, Stig Urheim, Barbara P Rogge, Robert M Persson, Dana Cramariuc
Journal: Circulation (2022)

Background: The interaction between left atrial (LA) mechanics and mitral valve remodeling patterns in patients with mitral regurgitation (MR) is poorly described. Objectives: To assess three-dimensional (3D) LA volumes and strain in relation to 3D mitral valve morphology in patients with degenerative vs. functional MR. Methods: Patients included in the 3D-PRIME (3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation) study at our heart valve clinic between 2020-2022 and with moderate or severe MR by combined transthoracic/transesophageal assessment were examined. LA remodeling was assessed by 3D maximum and minimum LA volume, reservoir strain (LASr) and contraction strain (LASct). Mitral valve annulus area, anterior and posterior leaflet length and area, tenting volumes and non-planar angle were measured using dedicated 3D mitral valve software. Results: 100 patients with moderate or severe MR were included. Patients with atrial functional MR (n=26) were older, more often women and had higher heart rate compared to degenerative MR (n=54) and ventricular functional MR (n=20) (p &lt;0.05). They also had larger LA volumes and severely impaired LASr and LASct despite smaller MR regurgitation volumes compared to MR by other mechanisms (Figure). Mitral annulus area was comparable between groups, but anterior mitral leaflet was higher, with larger area and the non-planar angle wider in functional MRs (p &lt;0.05). In multivariable analysis, low LASr (below median) was associated with larger LA volume, and higher anterior mitral leaflet height independent of age, sex, heart rate, left ventricular global longitudinal strain, and right ventricular stroke volume (Nagelkerke R 2 0.67, p &lt;0.01). In a similar model, low LASct was only associated with larger LA volumes. Conclusions: Patients with atrial functional MR have large LAs with severely impaired LA function and a specific mitral valve remodeling pattern at lower MR regurgitation volumes.
Abstract 11087: Impact of Frailty on Short-Term and Long-Term Outcomes Among St-Elevation Myocardial Infarction Patients Receiving Primary Percutaneous Coronary Intervention
Authors: Farshad Hosseini, Ian Pitcher, Mehima Kang, Martha MacKay, Joel Singer, Terry Lee, Kenneth Madden, John A CAIRNS, Graham C Wong, Christopher Fordyce
Journal: Circulation (2022)

Introduction: The impact of frailty on short-term and long-term outcomes in a contemporary STEMI population is unclear. We hypothesized that in STEMI patients undergoing primary percutaneous coronary intervention (pPCI) frailty would be independently associated with adverse in-hospital and 1-year outcomes. Methods: We retrospectively identified 1,579 STEMI patients aged ≥ 65 years who had received pPCI (2007 - 2020). A frailty index (FI) was determined using the health deficit accumulation model (Table 1). Frail patients were defined as those with a FI &gt; 0.25. The primary outcome was 1-year all-cause mortality. The composite adverse outcome comprised in-hospital all-cause mortality, cardiogenic shock, heart failure, re-infarction, major bleeding, or stroke. A multivariable model adjusting for age, sex, heart failure on presentation, infarct territory, prolonged reperfusion time, initial heart rate, and systolic blood pressure was performed. Results: There were 228 (14.4%) frail patients. Compared to non-frail patients, frail patients were older (mean 80.3 vs. 75.3 years, p &lt; 0.001) and had a higher comorbidity burden. After multivariable adjustment, baseline frailty was independently associated with increased 1-year all-cause mortality, in-hospital all-cause mortality, and the composite adverse outcome (Figure 1). Conclusions: In conclusion, among STEMI patients receiving pPCI, frailty was common and was independently associated with increased in-hospital and long-term adverse outcomes. These findings raise the need for early recognition of frailty and implementation of a comprehensive care model towards the management of frail patients.
Abstract 11282: Artificial Intelligence Derived Algorithm to Screen for Ebstein’s Anomaly of the Tricuspid Valve Utilizing Echocardiography
Authors: Chaitra Janga, Kan Liu, Heidi M Connolly, Christopher J McLeod, Alexander C Egbe, Carole A Warnes, Paul Friedman, Samuel Asirvatham, Malini Madhavan
Journal: Circulation (2022)

Introduction: Ebstein’s anomaly (EA) is a rare congenital anomaly of the tricuspid valve associated with heart failure and arrhythmias. Currently available imaging modalities like transthoracic echocardiography, cardiac magnetic resonance imaging (MRI), or computerized tomography (CT) are not viable for screening large asymptomatic populations. Hypothesis: A deep learning algorithm, implemented using a convolutional neural network (CNN) applied to the standard 12-lead ECG can be used as an accurate screening tool for EA in children and adults. Method: We identified 1,154 EA patients and 21,430 age- and sex-matched controls (1:20 ratio) between 1987 - 2020. A CNN was trained, validated and tested using digital 12-lead ECGs in 70%, 10% and 20% of the cohort respectively, divided by random shuffling. Results: The mean age was 26.68±19.23 years (41.8% aged &lt; 18 years, 56.41% female) for the EA cohort and 28.36±18.65 years (37.2% aged &lt;18 years, 55.67% female) for the control cohort. Following training and validation the area under the curve (AUC) for detecting EA in the testing cohort was 0.976 (95% CI 0.962 - 0.989) with prediction accuracy of 0.959. In subgroup analysis, the AUC was comparable in males (0.970, 95% CI 0.946-0.995) and females (0.979, 95% CI 0.964-0.994), those &lt;18 (0.980, 95% CI 0.958-1.000) and ≥18 years old (0.972, 95% CI 0.954-0.989), as well as in those with right bundle branch block (RBBB) (0.969, 95% CI 0.950-0.989) and without RBBB (0.950, 95% CI 0.922-0.978) on ECG. Conclusion: Artificial intelligence enhanced ECG based detection of EA is possible with high diagnostic accuracy. Following further refinement and external validation, this algorithm can facilitate early detection of EA using ECGs, a widely available and inexpensive tool. Figure: Receiver operating characteristic (ROC) curve for the performance of the artificial intelligence CNN in detecting EA in the test cohort stratified by (A) age (&lt; 18 and ≥ 18 years) and sex and (B) presence of RBBB.
Abstract 12210: Safety and Efficacy of Transcatheter Aortic Valve Replacement With Continuation vs Interruption of Peri-Procedural Anticoagulation: A Meta-Analysis
Authors: Siddharth Agarwal, Agam Bansal, Khawaja Akhtar, Jehanzeb khan, Muhammad Faraz Anwaar, Supriya Maheshwari, Nikita Garg, Usman Baber
Journal: Circulation (2022)

Introduction: Approximately 33% of patients undergoing transcatheter aortic valve replacement (TAVR) have an indication for long-term anticoagulation. In clinical routine, anticoagulation is often discontinued 2 to 4 days before TAVR. The purpose of this meta-analysis was to compare the safety and efficacy of TAVR in patients with per-procedural continuation vs interruption of anticoagulation. Methods: An electronic search was performed using PubMed and Ovid Medline from inception to May 2022. The primary outcome of interest was life-threatening or major bleeding. The secondary outcomes were all-cause mortality, stroke, vascular complications, need for blood transfusion, and closure device failure. Results: Three observational studies were included in our final analysis which consisted of 2,286 patients, with anticoagulation being continued in 1,069 patients and interrupted in 1,217 patients. Although, there was no significant difference in our primary outcome of life-threatening or major bleeding between both groups, there was a trend toward decreased risk of bleeding in patients who were continued on anticoagulation (RR: 0.81; CI: 0.65 to 1.0; I 2 : 0%, p=0.05). There was a significantly lower risk of stroke (RR: 0.55; CI: 0.35 to 0.88; I 2 : 0%, p=0.01) and need for blood transfusion (RR: 0.72; CI: 0.59 to 0.87; I 2 : 0%, p&lt;0.01) in patients who were continued on anticoagulation as compared to those in whom anticoagulation was interrupted. There was no significant difference in the all-cause mortality (RR: 0.76; CI: 0.49 to 1.19; I 2 : 10%, p=0.24), major vascular complications (RR: 0.86; CI: 0.68 to 1.09; I 2 : 0%, p=0.22), or closure device failure (RR: 0.90; CI: 0.51 to 1.59; I 2 : 0%, p=0.72) between both the cohorts. Conclusions: In a patient undergoing TAVR who requires long-term anticoagulation, continuing anticoagulation is superior to interrupting anticoagulation in reducing the risk of stroke without any increase in life-threatening or major bleeding.